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Women who have a hysterectomy with or without removal of the ovaries in mid-life do not appear to have an increased risk of cardiovascular disease, a study found.

Note that in general, trends in various risk factors over time did not differ when comparing women who underwent natural menopause with those who had a hysterectomy.

Women who have a hysterectomy with or without removal of the ovaries in mid-life do not appear to have an increased risk of cardiovascular disease, researchers found.

Changes in various cardiovascular risk factors over time were largely similar when comparing women going through natural menopause and those undergoing hysterectomy with or without oophorectomy, according to Karen Matthews, PhD, of the University of Pittsburgh, and colleagues.

There were some significant differences between the groups, but they could have been due to chance because of the large number of comparisons made, the researchers reported online in the Journal of the American College of Cardiology.

"The bottom line is that women who choose to have elective hysterectomy in mid-life don't seem to have an elevated risk for cardiovascular disease," Matthews said in an interview.

Results from some other studies, including the Women's Health Initiative, have suggested that hysterectomy may increase cardiovascular risk, although the relationship is not consistent in the literature. Matthews noted that previous studies exploring the issue have mostly included older women and less frequent follow-up compared with the current study.

"I think what we're doing is writing a new chapter on this important question of whether or not a hysterectomy has a negative or a positive effect on cardiovascular risk," she said.

Matthews and her colleagues examined data from the Study of Women's Health Across the Nation (SWAN), which enrolled premenopausal women ages 42 to 52 who were not taking hormone therapy and had an intact uterus and at least one ovary at baseline. The participants were followed annually for up to 11 years.

The current analysis included women who, by the end of the study, had reached natural menopause (1,769), had had a hysterectomy with ovarian conservation (77), or had had a hysterectomy with bilateral oophorectomy (106).

The most common symptoms or diagnoses associated with having a hysterectomy were suspected or diagnosed uterine fibroids (75.7%), suspected or diagnosed menorrhagia (58.6%), and chronic pelvic pain (25.7%).

In general, trends in various risk factors over time did not differ when comparing women who underwent natural menopause and those who had a hysterectomy.

Among women who underwent natural menopause, levels of LDL cholesterol, triglycerides, and apolipoprotein A increased leading up to and then following the final menstrual period, whereas HDL cholesterol levels decreased following the final menstrual period. Apolipoprotein B levels increased leading up to the final menstrual period and tended to decline thereafter.

Looking at other risk factors in the women who underwent natural menopause, there were steady increases in systolic blood pressure, tissue plasminogen activator-antigen (tPA-ag), and Factor VIIc, and decreases in plasminogen activator inhibitor-1 and C-reactive protein (CRP) over time.

Those trends were similar in the hysterectomy groups, except that women who had a hysterectomy with ovarian conservation had a greater increase in apolipoprotein A levels, a "modest" decrease in triglycerides before the surgery, and steady declines in tPA-ag. In addition, women who had a hysterectomy with bilateral oophorectomy had increases in CRP leading up to the surgery.

"Several cardiovascular disease risk factor changes did differ during the intervals prior to and following hysterectomy, compared to the changes prior to and following the final menstrual period, but not in a pattern suggesting increasing cardiovascular risk following hysterectomy," the researchers wrote.

"Thus, we conclude that hysterectomy with or without bilateral oophorectomy does not introduce a substantial increase in cardiovascular risk factors among mid-life women," they wrote.

They acknowledged several potential limitations of the analysis, including the possibility that the participants were not young enough to evaluate the effect of hysterectomy on cardiovascular disease risk because "bilateral oophorectomy may have a greater impact on ... risk if the surgery [is] performed at younger ages, when the decline in ovarian hormones would [be] more pronounced."

In addition, there was a low number of cases of hysterectomy with bilateral oophorectomy, and follow-up ended before the women reached the high-risk period after age 65, precluding an assessment of differences in clinical events between the groups.

The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institute on Aging, the National Institute of Nursing Research, and the National Institutes of Health Office of Research on Women's Health.

The authors reported that they had no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner